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Introduction There are no established methods to identify children with atypical diabetes for further study. We aimed to develop strategies to systematically ascertain cases of atypical pediatric diabetes using electronic medical records (EMR).Research design and methods We tested two strategies in a large pediatric hospital in the USA. Strategy 1: we designed a questionnaire to rule out typical diabetes and applied it to the EMR of 100 youth with diabetes. Strategy 2: we built three electronic queries to generate reports of three atypical pediatric diabetes phenotypes: unknown type, type 2 diabetes (T2D) diagnosed

Abstract Four-dimensional scanning transmission electron microscopy (4D-STEM) has recently gained widespread attention for its ability to image atomic electric fields with sub-Ångstrom spatial resolution. These electric field maps represent the integrated effect of the nucleus, core electrons and valence electrons, and separating their contributions is non-trivial. In this paper, we utilized simultaneously acquired 4D-STEM center of mass (CoM) images and annular dark field (ADF) images to determine the projected electron charge density in monolayer MoS2. We evaluate the contributions of both the core electrons and the valence electrons to the derived electron charge density; however, due to blurring by the probe shape, the valence electron contribution forms a nearly featureless background while most of the spatial modulation comes from the core electrons. Our findings highlight the importance of probe shape in interpreting charge densities derived from 4D-STEM and the need for smaller electron probes.

Background: The Le Fort I osteotomy is a commonly employed and predictable surgical technique used to treat maxillofacial deformities. While considered technically safe, orthognathic surgery can cause significant vascular complications. Presentation: This case report describes a 20-year old male who had undergone a routine Le Fort I osteotomy to treat maxillo-mandibular discrepancy, and subsequently developed an internal maxillary artery pseudoaneurysm that caused uncontrolled hemorrhage and hemodynamic instability. The patient ultimately required interventional radiology coil embolization for source control. Discussion: Although rare, internal maxillary artery pseudoaneurysms continue to be reported as postoperative complications in Le Fort I osteotomies, wherein coil-embolization technique remains a viable option for treatment. Additionally, the presentation of temporal swelling and retrobulbar pain may be useful in diagnosing the existence of a maxillary artery pseudoaneurysm. Conclusion: Pseudoaneurysm of the internal maxillary artery is a possible sequela of orthognathic surgery, and proper monitoring and management can avoid morbid outcomes.

Introduction Current health claims recognize the ability of oat ß-glucan to lower blood cholesterol; however, its ability to improve glycemic control is less certain. We undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) to update the evidence on the effect of oats and oat ß-glucan on glycemic control in individuals with diabetes.Research design and methods MEDLINE, EMBASE and Cochrane were searched (June 2021) for RCTs of ≥2 weeks investigating the effect of oat ß-glucan on glycemic control in diabetes. The outcomes were hemoglobin A1c (HbA1c), fasting glucose, 2-hour postprandial glucose (2h-PG) from a 75 g oral glucose tolerance test, homeostatic model assessment of insulin resistance (HOMA-IR) and fasting insulin. Independent reviewers extracted the data and assessed the risk of bias. Data were pooled using the generic inverse variance method. Heterogeneity was assessed (Cochran Q) and quantified (I2). Pooled estimates were expressed as mean difference (MD) with 95% CI. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach.Results Eight trial comparisons (n=407) met the eligibility criteria. All trials were in adults with type 2 diabetes who were predominantly middle-aged, overweight and treated by antihyperglycemic medications or insulin. A median dose of 3.25 g of oat ß-glucan for a median duration of 4.5 weeks improved HbA1c (MD, −0.47% (95% CI −0.80 to −0.13), pMD=0.006), fasting glucose (−0.75 mmol/L (−1.20 to –0.31), pMD

Background: Familial hypercholesterolemia (FH) is a common genetic disorder resulting in high levels of low-density lipoprotein cholesterol and increased risk of atherosclerotic cardiovascular disease. Genetic testing for FH is recommended but is not available in most of Canada. Consequently, there is a paucity of data regarding patient experiences with genetic testing. The objectives of this study were to investigate the attitudes and perspectives of patients with FH who underwent genetic testing. Methods: We administered an anonymous online survey to participants in the British Columbia Familial Hypercholesterolemia Registry who had undergone research-based genetic testing for FH. The survey included 25 questions and explored patients’ experiences with the genetic testing process, willingness to recommend genetic screening, and motivation to lower cholesterol levels. Results: Among 183 respondents, 38 (20.7%) had a positive genetic test result, 27 (14.8%) had a negative result, and 118 (64.4%) were awaiting their results. Compared with individuals awaiting their test results, participants with a positive genetic test were more likely to believe lipid-lowering therapy was highly important (74.3% vs 55.4%; P = 0.05). They were also more likely to strongly agree that a diagnosis of FH was important to them (71.1% vs 46.2%; P = 0.008), and were more likely to recommend genetic screening to their family members (85.9% vs 72.9%; P = 0.04). Conclusions: To our knowledge, this is the first study in Canada to explore the perspectives of patients with FH who underwent genetic testing. These results suggest that genetic testing for FH might offer benefits in important patient-centred outcomes. Résumé: Introduction: L’hypercholestérolémie familiale (HF) est une maladie génétique fréquente qui entraîne des concentrations élevées de cholestérol à lipoprotéines de faible densité et un risque accru de maladies cardiovasculaires athérosclérotiques. L’analyse génétique de l’HF est recommandée, mais n’est pas disponible dans la plupart des régions du Canada. Par conséquent, il existe peu de données sur les expériences des patients ayant subi une analyse génétique. Les objectifs de la présente étude étaient d’enquêter sur les attitudes et les points de vue des patients atteints d’HF qui avaient subi une analyse génétique. Méthodes: Nous avons administré une enquête anonyme en ligne aux participants inscrits dans le registre British Columbia Familial Hypercholesterolemia qui avaient subi une analyse génétique fondée sur la recherche pour l’HF. L’enquête comptait 25 questions et portait sur les expériences des patients sur le processus d’analyse génétique, la volonté de recommander le dépistage génétique et la motivation à abaisser les concentrations de cholestérol. Résultats: Parmi les 183 répondants, 38 (20,7 %) avaient des résultats positifs à l’analyse génétique, 27 (14,8 %) avaient des résultats négatifs et 118 (64,4 %) attendaient leurs résultats. Comparativement aux individus qui attendaient leurs résultats d’analyse, les participants qui avaient des résultats positifs à l’analyse génétique étaient plus susceptibles de penser que le traitement hypolipémiant était très important (74,3 % vs 55,4 %; P = 0,05). Ils étaient aussi plus susceptibles d’être tout à fait d’accord sur le fait que le diagnostic d’HF était important pour eux (71,1 % vs 46,2 %; P = 0,008) et de recommander le dépistage génétique aux membres de leur famille (85,9 % vs 72,9 %; P = 0,04). Conclusions: À notre connaissance, au Canada, c’est la première étude sur les points de vue des patients atteints d’HF qui avaient subi une analyse génétique. Ces résultats indiquent que le dépistage génétique de l’HF pourrait favoriser des résultats importants axés sur le patient.

Maintaining an adequate water supply is one of the key challenges faced by the Dallas-Fort Worth Metroplex, where increasing population and rising water demand have elevated the vulnerability of the communities to water shortages. In this paper, we conducted a preliminary study exploring the possibility of converting flood storage in the Joe Pool Lake (JPL) as a means to improve water supply reliability and achieve better cost efficiency. This study employs a mixed integer linear programming (MILP) approach that considers the costs of meeting conversion demand and supply requirements over the northern portion of the Trinity River Basin. It includes trade-offs between capturing and storing natural flow versus return flow from the treatment facilities of the Trinity River Authority (TRA). A set of hypothetical prices and demand figures with the record drought of 1940-1996 considered to test the LP model. The optimal strategy yields expansion of JPL and associated storage-diversion on an annual basis. Also, the outcomes of the analyses suggest that, while the conversion would have a positive impact on water availability, storing the return flow might not produce sufficient cost savings; unless higher prices were imposed on the stored-return flow.

AimsUnderstanding atypical forms of diabetes (AD) may advance precision medicine, but methods to identify such patients are needed. We propose an electronic health record (EHR)-based algorithmic approach to identify patients who may have AD, specifically those with insulin-sufficient, non-metabolic diabetes, in order to improve feasibility of identifying these patients through detailed chart review.MethodsPatients with likely T2D were selected using a validated machine-learning (ML) algorithm applied to EHR data. "Typical" T2D cases were removed by excluding individuals with obesity, evidence of dyslipidemia, antibody-positive diabetes, or cystic fibrosis. To filter out likely type 1 diabetes (T1D) cases, we applied six additional "branch algorithms," relying on various clinical characteristics, which resulted in six overlapping cohorts. Diabetes type was classified by manual chart review as atypical, not atypical, or indeterminate due to missing information.ResultsOf 114,975 biobank participants, the algorithms collectively identified 119 (0.1%) potential AD cases, of which 16 (0.014%) were confirmed after expert review. The branch algorithm that excluded T1D based on outpatient insulin use had the highest percentage yield of AD (13 of 27; 48.2% yield). Together, the 16 AD cases had significantly lower BMI and higher HDL than either unselected T1D or T2D cases identified by ML algorithms (PConclusionOur EHR-based algorithms followed by manual chart review identified collectively 16 individuals with AD, representing 0.22% of biobank enrollees with T2D. With a maximum yield of 48% cases after manual chart review, our algorithms have the potential to drastically improve efficiency of AD identification. Recognizing patients with AD may inform on the heterogeneity of T2D and facilitate enrollment in studies like the Rare and Atypical Diabetes Network (RADIANT).

We present the unique case and treatment of condylar resorption of the temporomandibular joint due to childhood physical trauma in a 38-year-old woman. The patient suffered mandibular trauma as a child, developing severe facial skeletal deformities that caused significant esthetic and functional deficiencies. This case demonstrates that hemimandibular hypoplasia and condylar resorption in the setting of past trauma can be successfully treated with a LeFort 1 osteotomy, sagittal split mandibular osteotomy, inverted L mandibular osteotomy, genioplasty, and an anterior iliac crest bone graft without any significant complications or need for total joint replacement, resulting in substantial improvement in occlusion and facial symmetry.

Background: The Eastern Cape province of South Africa has one of the highest burdens of HIV in the world. Emergency Departments (EDs) can serve as optimal clinical sites for the identification of new HIV infections and entry into care. We sought to determine the current burden of HIV disease among ED patients in the Eastern Cape. Methods: We conducted a prospective cross-sectional observational study in the EDs of three Hospitals in the Eastern Cape province of South Africa from June 2017 to July 2018. All adult, non-critical patients presenting to the ED were systematically approached and offered a Point-Of-Care (POC) HIV test in accordance with South African guidelines. All HIV-positive individuals had their blood tested for the presence of antiretroviral therapy (ART) and the presence of viral suppression (≤1000 copies/ml). HIV incidence was estimated using a multi-assay algorithm, validated for a subtype C epidemic. Findings: Of the 2901 patients for whom HIV status was determined (either known HIV-positive or underwent POC HIV testing), 811 (28.0%) were HIV positive, of which 234 (28.9%) were newly diagnosed. HIV prevalence was higher in Mthatha [34% (388/1134) at Mthatha Regional Hospital and 28% (142/512) at Nelson Mandela Academic Hospital], compared to Port Elizabeth [22% (281/1255) at Livingstone Hospital]. HIV incidence was estimated at 4.5/100 person-years (95% CI: 2.4, 6.50) for women and 1.5 (CI 0.5, 2.5) for men. Of all HIV positive individuals tested for ART (585), 54% (316/585) tested positive for the presence of ARTs, and for all HIV positive participants with viral load data (609), 49% (299/609) were found to be virally suppressed. Interpretation: Our study not only observed a high prevalence and incidence of HIV among ED patients but also highlights significant attrition along the HIV care cascade for HIV positive individuals. Furthermore, despite developing an optimal testing environment, we were only able to enrol a small sub-set of the ED population. Given the high HIV prevalence and high attrition in the ED population, HIV services in the ED should also develop strategies that can accommodate large testing volumes and ART initiation. Keywords: HIV testing, HIV in men, South Africa, Emergency medicine, HIV and trauma

Abstract Background There has been an exponential increase in the offering of short-term international field experiences in recent years in response to student demands for global health opportunities. Pre-departure preparation is an essential component to equip trainees with the adequate safety, wellness, and cultural competence needed to engage in a meaningful and mutually beneficial elective. This review seeks to quantify the plethora of pre-departure preparation training available to public health, clinical, and undergraduate trainees across the continuum of education for short-term experiences in low-and middle-income countries (LMICs). Methods We performed a systematic review of Pubmed, Embase, Web of Science, Scopus, and Ovid Global Health in February, 2018. A three-concept search was employed and included “global or international health”; “education or preparation of personnel/students”; and “field programs or travel.” The study teamed used PRISMA reporting guidelines to conduct title and full-text reviews and conduct data extraction and analysis. Results The search returned 2506 unique articles. Of these, 55 met inclusion criteria and were included in the final review. Ninety one percent (91%) of articles focused on pre-departure trainings for medical students and residents. Nine thematic domains for short-term international field experiences emerged; culture, safety, and project-specific knowledge were the most frequently covered domains while mentorship, professionalism, and emotional wellness and culture shock were least common. Approximately half (53.3%) of studies specifically evaluated the pre-departure component of the international experience using a survey or evaluation form. Recommendations emerged from these evaluations including early engagement with international partners, inclusion of self-reflection exercises and site-specific content, and utilization of interactive approaches in learning. Some institutions face barriers to conducting pre-departure preparation such as lack of dedicated faculty, finances, and institutional support. Conclusions Interest in pre-departure training for international experiences is growing but few programs conduct and publish evaluations of these trainings. Pre-departure trainings should be developed in partnership with receiving institutions and faculty and incorporate critical self- reflection throughout the experience. In addition to the experience itself, institutions need to evaluate these curricula to better understand how they influence trainees’ capacity to effectively engage in LMIC settings.

Abstract Background Bone marrow stromal cells (BMSCs) are a heterogeneous population that participates in wound healing, immune modulation and tissue regeneration. Next generation sequencing was used to analyze transcripts from single BMSCs in order to better characterize BMSC subpopulations. Methods Cryopreserved passage 2 BMSCs from one healthy subject were cultured through passage 10. The transcriptomes of bulk BMSCs from designated passages were analyzed with microarrays and RNA sequencing (RNA-Seq). For some passages, single BMSCs were separated using microfluidics and their transcriptomes were analyzed by RNA-Seq. Results Transcriptome analysis by microarray and RNA-Seq of unseparated BMSCs from passages 2, 4, 6, 8, 9 and 10 yielded similar results; both data sets grouped passages 4 and 6 and passages 9 and 10 together and genes differentially expressed among these early and late passage BMSCs were similar. 3D Diffusion map visualization of single BMSCs from passages 3, 4, 6, 8 and 9 clustered passages 3 and 9 into two distinct groups, but there was considerable overlap for passages 4, 6 and 8 cells. Markers for early passage, FGFR2, and late passage BMSCs, PLAT, were able to identify three subpopulations within passage 3 BMSCs; one that expressed high levels of FGFR2 and low levels of PLAT; one that expressed low levels of FGFR2 and high levels of PLAT and one that expressed intermediate levels of FGFR2 and low levels of PLAT. Conclusions Single BMSCs can be separated by microfluidics and their transcriptome analyzed by next generation sequencing. Single cell analysis of early passage BMSCs identified a subpopulation of cells expressing high levels of FGFR2 that might include skeletal stem cells.

Partnerships with students are considered one of the principles of good Scholarship of Teaching and Learning (SoTL) practice. However, not all partnerships are equally successful. What characteristics are common to successful partnerships and what preparatory elements can lead toward more successful partnerships? In this article, our team of graduate students, educational developers, and faculty members engage in detailed self-reflection on our past and ongoing SoTL projects as an inquiry into what it means to be in a successful student-faculty/staff partnership. Using thematic analysis, we identify and describe four distinct domains that can shape partnerships: (1) motivations to participate, (2) challenges, (3) power, and (4) definitions of success. The article concludes with a set of questions to stimulate initial and ongoing conversations between partners to guide new partnerships in defining the parameters for success in their proposed collaboration. Les partenariats avec les étudiants sont considérés comme l’un des principes de bonne pratique de l’Avancement des connaissances en enseignement et en apprentissage (ACEA). Toutefois, tous les partenariats ne connaissent pas le même succès. Quelles sont les caractéristiques communes des partenariats réussis et quels sont les éléments préparatoires qui peuvent aboutir à des partenariats mieux réussis? Dans cet article, notre groupe, consistant d’étudiants de cycles supérieurs, de conseillers pédagogiques et de professeurs, se lance dans une auto-réflexion détaillée sur nos projets passés et présents en ACEA qui constitue une enquête sur ce que cela signifie de faire partie d’un partenariat réussi entre étudiants, professeurs et membres du personnel. Par le biais de l’analyse thématique, nous identifions et décrivons quatre domaines distincts qui façonnent les partenariats : 1) la motivation à participer, 2) les défis, 3) le pouvoir et 4) les définitions de la réussite. En conclusion, nous posons un groupe de questions pour stimuler les conversations initiales et continues entre les divers partenaires afin de guider les nouveaux partenariats à définir les paramètres menant à la réussite dans leur collaboration proposée.

Recent work has revealed that raising-to-object (RTO) constructions across languages impose two common constraints. Constructions that involve an actual movement of the “raised” phrase (XP) invariably impose a “Subject-only” constraint on XP, whereas those that contain an XP base-generated in its spell-out position require a coindexed pronoun in the embedded clause. This paper investigates an understudied type of RTO construction in the Philippine-type Austronesian language Puyuma, in which a “Subject-only” constraint on the XP is absent, and the construction need not contain an embedded pronoun coindexed with the XP. I demonstrate that the absence of these constraints follows from an embedded hanging topic analysis of the XP, whereby the XP is base-generated at the left periphery of a finite embedded clause, whose relation with the embedded CP is established through the aboutness condition. I discuss how this construction enriches the current understanding of the microvariation found in non-movement-type RTO constructions. Finally, I show that the XPs, in instances of RTO that have been analyzed as embedded topic constructions, exhibit variation in behavior parallel to topics in root clause environments, which calls for further investigation of the correlation between topics and XPs in RTO constructions.

Higher education can be seen as a “gateway” to entering professional careers (Rubenson, 2010), yet the teaching and learning practices used in the classroom may not always prepare students for their futures the way instructors intended, one example is the use of student participation to increase interaction and learning in the classroom. Although verbalizing thoughts can help students learn, students in this study felt they were more often rewarded for frequency of their contribution instead of quality of their contribution which challenges its intended use. They called it “verbal diarrhea” and explained how prominent it was in their university learning experiences making the learning environment not only disengaging and a practice they dreaded but also unrealistic to the real world setting. However, in the Active Learning Classroom (ALC), students noticed verbal diarrhea was significantly reduced and for the most of the time non-existent, and made their learning more authentic (Herrington, Reeves, & Oliver, 2014). This paper presents case studies of students’ lived experiences in their undergraduate degree, and their “prescriptions” and recommendations to instructors and other students on avoiding verbal diarrhea and encouraging meaningful discussions facilitated by the learning environment.

Active Learning Classrooms are new learning spaces that allow collaborative learning activities to take place easily over the traditional classroom. However, some features of these rooms could be viewed as “distracting” to students’ learning such as the multiple interactive screens. The purpose of this paper is to begin the conversation on how subtle roles in the learning environment could impact learning. Using a case study approach, an activity from one course was chosen that exemplified how peers outside students’ immediate group can influence their learning. Based on the preliminary findings, it is suggested that being aware of these subtle roles peers outside the group can have on students and making them explicit in the pedagogical design of the course can lead to maximizing the usage of the space to potentially foster greater learning.

This paper examines the effect of the architectural layout of two classrooms (one flexible and one less-flexible) on Teaching Assistants’ (TAs) movement and interactions with students. Four TAs from a first-year undergraduate introductory course were chosen for the two studies. In study 1, the TAs taught the same lesson twice to two groups of students on the same day but in different classrooms, thereby controlling for content differences. Study 2 investigated the impacts that flexible and non-flexible spaces have on the same cohort of students, as the TAs continued to teach the same students but the students switched classrooms for the second half of the course, thereby controlling for differences in student participants. From the video analyses, there was a clear difference in how the TAs moved in the classroom and the interactions they had with students. Both TAs and students reported in surveys that there was a difference in their movement in the respective rooms that had an impact on their teaching and learning quality. This finding starts the conversation on how space can affect TAs, in order for TAs to consider how their movement is affected by classroom configurations, and how this change in movement can affect teaching strategies and impact their students’ learning.

Education is meant to open your mind, but is that what universities are really doing? Rather than fostering open-minded thinking, the format of lecturing, the lack of interaction among students and instructors, and the passive nature of learning are likely producing the opposite, students with closed-minds. The development and implementation of Active Learning Classrooms (ALC) has the capability to counteract this negative trend by providing a configuration suited for more collaborative learning and opportunities for students to share their thoughts, hear other perspectives from peers, and have the potential to become more open-minded. A description of a study on students in a fourth year psychology course is provided in which the instructor changed her course in order to use the ALC to its fullest capacity. Students were also given an Actively Open-minded Thinking questionnaire (Stanovich & West, 1997) pre and post course, with results indicating that open-minded thinking increased over the term. Although there are many components that could contribute to this result, the impact that educational spaces may have on student learning are discussed.

Background: Longitudinal or time-dependent activity data are useful to characterize the circadian activity patterns and to identify physical activity differences among multiple samples. Statistical methods designed to analyze multiple activity sample data are desired, and related software is needed to perform data analysis. Methods: This paper introduces a functional data analysis (fda) approach to perform a functional analysis of variance (fANOVA) for longitudinal circadian activity count data and to investigate the association of covariates such as weight or body mass index (BMI) on physical activity. For multiple age group adolescent school girls, the fANOVA approach is developed to study and to characterize activity patterns. The fANOVA is applied to analyze the physical activity data of three grade adolescent girls (i.e., grades 10, 11, and 12) from the NEXT Generation Health Study 2009–2013. To test if there are activity differences among girls of the three grades, a functional version of the univariate F-statistic is used to analyze the data. To investigate if there is a longitudinal (or time-dependent activity count) difference between two samples, functional t-tests are utilized to test: (1) activity differences between grade pairs; (2) activity differences between low-BMI girls and high-BMI girls of the NEXT study. Results: Statistically significant differences existed among the physical activity patterns for adolescent school girls in different grades. Girls in grade 10 tended to be less active than girls in grades 11 & 12 between 5:30 and 9:30. Significant differences in physical activity were detected between low-BMI and high-BMI groups from 8:00 to 11:30 for grade 10 girls, and low-BMI group girls in grade 10 tended to be more active. Conclusions: The fda approach is useful in characterizing time-dependent patterns of actigraphy data. For two-sample data defined by weight or BMI values, fda can identify differences between the two time-dependent samples of activity data. Similarly, fda can identify differences among multiple physical activity time-dependent datasets. These analyses can be performed readily using the fda R program.